Type 2 Diabetes Mellitus with Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State and Metabolic Syndrome in a 16-Year-Old Boy: Lifestyle Modification as Management

Background: Type 2 diabetes mellitus (T2DM) is characterized by hyperglycemia with insulin resistance and impaired insulin secretion. The severest form of T2DM present with hyperglycemia crisis such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), or mixed syndrome (DKA and HHS). Management of children with T2DM is combination of pharmacology and lifestyle modification. Healthier lifestyle, proper nutrition, and routine exercise can be the key management of T2DM. Objective: The aim of this case report is to describe the combination of pharmacology and lifestyle modification as the management of T2DM in children. Case: A 16-year-old boy was presented with obesity. There was no classic sign of diabetes mellitus (DM) and vomiting. He was alert with no kussmaul breath, high blood pressure, sign of mild dehydration, and acanthosis nigricans on his neck. Laboratory tests revealed high blood glucose, metabolic acidosis, high blood osmolarity, with ketonuria and glucosuria. Low C-peptide with negative result of Insulin Autoantibody (IAA), confirmed of T2DM with a mixed syndrome and metabolic syndrome (MeTS). The patient was treated with rehidration, electrolyte correction, and intravenous insulin. One year of follow up with a lifestyle modification, the patient succeeded to decrease his body weight, his blood glucose was normal, and reached HbA1c level 5 % without any medication. Conclusion: Lifestyle modification can be the management of children with T2DM presenting with MeTS.